An Unintended Consequence of HB 746

With House Bill 746 looming over North Carolinians, it is important to understand what the bill could mean for public health in the state. This concealed carry bill would make critical changes to current North Carolina gun laws, including: lowering the minimum age requirement to be able to carry a concealed handgun from 21 to 18 years old; no longer requiring a firearms safety training class and live fire training; and allowing concealed carry without a permit in areas where open carry is currently permitted, and in some sensitive places like houses of worship that also have schools, outside of school hours.

HB 746 has been a catalyst for a robust conversation about gun legislation in North Carolina. Law enforcement and concealed carry instructors alike are concerned about the possible impact these changes could have on the public. A specific problem area for these groups is the removal of a gun-training requirement. Firearm safety training is intended to ensure that gun owners know how to safely carry a gun, and to provide practical knowledge of the state’s law regarding guns and self-protection.

While the proposed elimination of the training requirement has garnered plenty of attention, the likely broader public health impact of this bill has not been talked about much. Any change to existing law that has the effect of increasing the number of guns in the hands of younger adults – as the proposed law is likely to do – also has the potential to increase the suicide rate. The reason is that suicide attempts are relatively common in this age group, and suicide attempts with guns are almost always fatal.

According to Dr. Jeffrey Swanson, Professor in Psychiatry and Behavioral Sciences at the Duke University School of Medicine, “the suicide mortality rate increases pretty dramatically in the period from adolescence to young adulthood – about 50%.” He points out that the proposed law would extend concealed carry to an age group with an increased risk of suicide.

Many people are surprised to learn that suicide is the leading reason for death from a gun in the United States. “We know that about two thirds of all gun fatalities, depending on the state, are from suicide” added Dr. Swanson. “If we are going to have a culture of guns, we should have a culture of gun safety, and that includes knowing how to use a gun, storing it safely, and supporting sensible laws to try and keep firearms out of the hands of people who may be at high risk of harming themselves or others with a gun… Loosening those kinds of restrictions and not requiring gun safety training are probably two steps in the wrong direction.”

Rather than focusing on finding new ways to loosen gun restrictions, and thus introduce more guns to people in North Carolina, we should be doing what we can to ensure that people are safe with the guns that they already own. Connecticut and Indiana are two states, among a list of several others, that have taken action to help ensure their citizens’ safety by enacting preemptive gun removal laws. These laws typically allow concerned family members and police officers to seek a civil court order to have guns temporarily removed from a person at high risk of harming self or others. In a study examining the impact of the law in Connecticut, Swanson and his colleagues found that for every 10 to 20 gun seizures made, a potential suicide was prevented.[1]

Every self-injury attempt is worth preventing, but it is especially important to prevent suicide attempts with guns, because firearms are far more lethal than most other means of intentional injury. According to CDC data, in 2015, only about 4% of all intentional self-injuries using other means (not guns) were fatal, while about 85% of self-injury attempts using a gun were fatal – that is, completed suicides. Viewing the 2015 data differently, while only about 4% of all intentional self-injury attempts involved guns, about 50% of fatal attempts involved guns. In short, although guns are used infrequently in self-harm attempts, when guns are used, they very frequently result in death.

That is why finding a solution that is not simply providing people with more guns is key. Increasing the number of people carrying guns will increase the likelihood that someone will be harmed with a gun, including the gun owner. As an alternative, an important part of the solution to gun violence is to focus policy efforts on limiting and reducing, not expanding, gun access for those who are at high risk of seriously harming themselves or others.

Preemptive gun removal laws are one solution to reduce gun violence. “I think it is an important piece in the gun violence prevention puzzle, especially in a country like ours, where if you just stop someone from buying a gun, and they already have seven guns at home – which is the average number removed in these gun seizure actions – then it might not deter violence,” Swanson said. “I think this is a useful legal tool and it is surprisingly the kind of policy that people can agree on even if they disagree on gun ownership.”

The views expressed throughout this article by Dr. Jeffrey Swanson are his and do not necessarily represent the position of Duke University.